Tetanus Deaths Before We Had Vaccines

We often hear that people rarely die with tetanus anymore, but some don’t understand that’s simply because most people are vaccinated and protected these days. It is not because tetanus has gone away or because we have a cure if you get tetanus. So how many tetanus deaths were there before we had vaccines?

Before vaccines, even a slight abrasion would lead to a tetanus death. — In the pre-vaccine era, even a “slight abrasion” could lead to a deadly tetanus infection. It still can if you aren’t vaccinated and protected!

Before we talk about the pre-vaccine era, it is important to note that even today, around the world:

around 25,000 newborns die each year from neonatal tetanus
there are still up to 293,000 tetanus deaths each year, mostly in unvaccinated and partially vaccinated children and adults

While those are large numbers, that’s a big reduction from before we had tetanus vaccines!

History of Tetanus Vaccines

When was that?

The first tetanus vaccine was developed in 1926 by Gaston Ramon and Christian Zoeller.

They used formaldehyde (formalin) to weaken the tetanus exotoxin that the Clostridium tetani bacteria make just enough so that it would not cause active disease, but could still trigger an immune response.

Remember, with tetanus, it is this exotoxin from the C. tetani infection that makes you sick and can kill you.

Before that first tetanus vaccine, beginning in 1891, anti-tetanic serum (tetanus antitoxin) produced in horses was used to treat tetanus. Emil von Behring and Shibasaburo Kitasato had discovered the previous year that they could recover the antitoxin (antibodies to the exotoxin) from animals given tetanus exotoxin and that large doses of this antitoxin would protect other animals from the effects of the tetanus exotoxin.

While effective, this passive immunization regimen could cause serum sickness and anaphylaxis. And the antibodies didn’t last long, leading many patients to require multiple antitoxin injections so that they didn’t relapse and still get tetanus.

Looking at the history of tetanus cases and deaths, you can see a significant drop after the first vaccine was developed. — While improved hygiene and sanitation contributed to the drop in tetanus cases and deaths, most of it came from the introduction of tetanus antitoxin and then a tetanus vaccine.

Later, in 1938, the tetanus vaccine was improved, when tetanus toxoid was absorbed to aluminum as an adjuvant. That’s when it finally became commercially available.

The Fourth of July used to be called Tetanus Day because of all of the tetanus cases and deaths. — The Fourth of July used to be called Tetanus Day because of all of the children who would develop tetanus after getting minor injuries playing with fireworks and cap guns!

Still, it took time before more people began to get vaccinated and protected. In fact, tetanus vaccines weren’t widely used until World War II.

Next, the tetanus vaccine was combined with diphtheria and pertussis to become the DTP vaccine in 1948.

The history of tetanus vaccines includes yearly tetanus shots to prevent cases and deaths. — Immunization schedules from the 1940s. Note the annual tetanus shots and that children at the time often got many more vaccines than you are made to believe.

Interestingly, people used to get yearly tetanus shots!

“The child who got a toxoid injection after a cut three months ago comes in to the office today with another cut, and gets another dose of toxoid. The child who goes regularly to a summer camp is informed that he must have his “annual” tetanus toxoid booster before going to camp. Some industrial medical services follow a similar policy, and so it goes with many other groups and employers.”
Excessive Use of Tetanus Toxoid Boosters

It was in 1967 that Thomas Peebles, a pediatrician, did a study and found that we could move to the current ten year booster regimen.

Also in the 1960s, human tetanus immunoglobulin began to replace horse antitoxin. This version was safer and lasted a little longer, but you still need a dose of tetanus vaccine for long lasting protection for high risk wounds. Tragically, this safer version is still not available everywhere, which is something to consider if you are traveling out of the country with your unvaccinated child.